NHS funding

In real terms the budget is expected to increase from £117.229bn in 2015/16 to £120.151bn by 2019/20.

Health expenditure (medical services, health research, central and other health services) per capita in England has risen from £1,868 in 2010/11 to £2,057 in 2014/15.

The NHS net deficit for the 2015/16 financial year was £1.851 billion (£599m underspend by commissioners and a £2.45bn deficit for trusts and foundation trusts).

The most recently published national surveys of investment for mental health found there had been real terms reductions of 1 per cent for working age adults and 3.1 per cent for older people in 2011/12.

There were 32,467 additional doctors employed in the NHS in 2014 compared to 2004. The number has increased by an annual average of 2.5 per cent over that time.

There were 18,432 more NHS nurses in 2014 compared to ten years earlier. The number has increased by an annual average of 0.5 per cent over that period.

There were 5,729 more GPs and 1,688 more practice nurses employed by GPs in 2014 than ten years earlier.

There were 12,432 more qualified allied health professionals in 2014 compared to 2004. However the number of qualified healthcare scientists has declined for each of the past five years, with the number in 2014 874 below that of 2004.

51.5 per cent of NHS employees across HCHS and GP services are professionally qualified clinical staff. A further 26.6 per cent provide support to clinical staff in roles such as nursing assistant practitioners, nursing assistant/auxiliaries and healthcare assistants.

An NHS Partners Network survey shows that more than 69,000 individuals are involved in providing front-line services to NHS patients among their membership. Approximately two-thirds are clinicians.

Between 2009 and 2015 the number of professionally qualified clinical staff within the NHS has risen by 3.9 per cent. This rise includes an increase in doctors of 8.9 per cent; a rise in the number of nurses of 0.7 per cent; and 6.8 per cent more qualified ambulance staff.

Medical school intake rose from 3,749 in 1997/98 to 6,262 in 2012/13 - a rise of 67.0 per cent.

Management

Managers and senior managers accounted for 2.35 per cent of the 1.318 million staff employed by HCHS and GP services across the NHS in 2015.

The number of managers and senior managers increased slightly in 2014 and 2015, having declined in each of the previous four years. However 30,952 was the second lowest total since the new dataset starts in 2009.

In 2008/09 the management costs of the NHS had fallen from 5.0 per cent in 1997/98 to 3.0 per cent.

International comparisons

In comparison with the healthcare systems of ten other countries (Australia, Canada, France, Germany, Netherlands, New Zealand, Norway, Sweden, Switzerland and USA) the NHS was found to be the most impressive overall by the Commonwealth Fund in 2014.

The NHS was rated as the best system in terms of efficiency, effective care, safe care, coordinated care, patient-centred care and cost-related problems. It was also ranked second for equity.

However in the category of healthy lives (10th), the NHS fared less well.

Current health expenditure in the UK was 9.78 per cent of GDP in 2015. This compares to 16.91 per cent in the USA, 11.08 per cent in Germany, 11.01 per cent in France, 10.76 per cent in the Netherlands, 10.59 per cent in Denmark, 10.16 per cent in Canada, 9.05 per cent in Italy and 9.00 per cent in Spain.

Current expenditure per capita (using the purchasing power parity) for the UK was $4,015 in 2015. This can be compared to $9,451 in the USA, $5,343 in the Netherlands, $5,267 in Germany, $4,943 in Denmark, $4,614 in Canada, $4,415 in France, $3,272 in Italy and $3,153 in Spain.

The UK had 2.8 physicians per 1,000 people in 2015, compared to 4.1 in Germany (2014), 3.9 in Italy (2014), 3.8 in Spain (2014), 3.5 in Australia (2014), 3.4 in France, 3.0 in New Zealand and 2.6 in Canada (2014).

The UK had 2.7 hospital beds per 1,000 people in 2014, compared to 8.2 in Germany, 6.2 in France, 3.0 in Spain, 2.8 in New Zealand and 2.7 in Denmark.

Average length of stay for all causes in the UK was 6.9 days in 2014. This compares to 16.9 in Japan, 9.0 in Germany, 7.8 in Italy, 7.6 in New Zealand (2013), 6.6 in Spain and 5.6 in France.

Patient experience

In the 2015 Care Quality Commission inpatient satisfaction survey 84 per cent of c83,000 respondents rated their overall experience as 7 or more out of 10.

84 per cent felt that they were always treated with dignity and respect while using inpatient services.

83 per cent felt they were 'definitely' provided with enough information about their condition by the person that referred them.

98 per cent felt their hospital room or ward was 'very' or 'fairly' clean.

82 per cent and 79 per cent 'always' had confidence and trust in the doctors and nurses treating them respectively.

In the 2011 Care Quality Commission outpatient survey 95 per cent of people using outpatient services reported their care as being excellent (44 per cent), very good (39 per cent) or good (12 per cent).

89 per cent of people agreed that they were treated with dignity and respect at all these times while visiting outpatient services.

65 per cent of respondents to the CQC's community mental health services survey for 2016 rated their experience between 7 and 10 out of 10.

70 per cent 'definitely' felt listened to carefully and 56 per cent 'definitely' felt as involved as they wanted to be in agreeing the care they received. Both of these percentages were unchanged on the previous year's community mental health survey.

In September 2016 95.41 per cent of 212,630 inpatients treated by NHS trusts and foundation trusts would recommend their provider to friends or family (23.9 per cent response rate). For 17,749 inpatients treated by independent sector organisations, the proportion was 98.74 per cent (38.3 per cent response rate).

Aggregated GP Patient Survey results from January-March 2015 and July-September 2015 found that 84.9 per cent of respondents rated their overall experience at the GP surgery as 'very good' or 'fairly good.'

84.9 per cent felt their GP was good at treating them with care and concern. 73.3 per cent rated their overall experience at making an appointment as good.

67.0 per cent stated their overall experience of out-of-hours GP services was good.

NHS activity

The NHS deals with over 1 million patients every 36 hours.

In 2015/16 there were 40 per cent more operations ('procedures and interventions' as defined by Hospital Episode Statistics, excluding diagnostic testing) completed by the NHS compared to 2005/06, with an increase from 7.215m to 10.119m.

There were 16.252m total hospital admissions in 2015/16, 28 per cent more than a decade earlier (12.679m).

The total annual attendances at Accident & Emergency departments was 22.923m in 2015/16, 22 per cent higher than a decade earlier (18.759m).

The proportion of patients seen within 4 hours at A&E departments in 2015/16 was 87.9 per cent in major (type 1 units) and 91.9 per cent overall.

The total number of outpatient attendances in 2014/15 was 85.632m, an increase of 4.4 per cent on the previous year (82.060m).

In the 2015 calendar year, 482,120 NHS patients were admitted to independent providers for their elective inpatient care. There were 802,949 referrals made by GPs to independent providers for outpatient care during the same period.

There were 1.836m people in contact with specialist mental health services in 2014/15. 103,840 (5.7 per cent) spent time in hospital.

There were 21.034m outpatient and community contacts arranged for mental health service users in 2014/15.

58,399 people were detained under the Mental Health Act in 2014/15.

There were 3.140m category A calls (Red 1 and Red 2) that resulted in an emergency response in 2014/15, 9.3 per cent more than the previous year (2.872m).

71.9 per cent of Red 1 ambulance calls were responded to within eight minutes in 2014/15.

At the end of September 2016, there were 3.703 million patients on the waiting list for treatment. 348,542 (9.4 per cent) had been waiting for longer than 18 weeks, compared to 247,388 (7.5 per cent) at the same point in 2015.

The number of patients waiting longer than a year for treatment declined from 20,097 in September 2011 to 214 in November 2013, before increasing again. In September 2016 the number stood at 1,181. Over the past three years, the number waiting in excess of 26 weeks has increased from 48,769 to 108,459 in September 2016.

85.6 per cent of people with admitted pathways (adjusted) were treated within 18 weeks of referral in September 2015, compared to 88.3 per cent a year earlier. That was the last month for which this target was applied.

90.3 per cent of people with non-admitted pathways were treated or discharged within 18 weeks of referral in September 2016, compared to 93.7 per cent a year earlier.

In September 2016, 77.5 per cent of service users who had completed their care pathway were seen within two weeks of referral under the new Early Intervention in Psychosis access standard.

At the end of September 2016, 882,312 patients were on the waiting list for a diagnostic test. Of these, 1.5 per cent had been waiting in excess of six weeks.

Health and population

Life expectancy for English men in 2013-15: 79.4 years.

Life expectancy for English women in 2013-15: 83.1 years

The UK population is projected to increase from an estimated 64.6 million in mid-2014 to 69.0 million by 2024 and 72.7 million by 2034.

The UK population is expected to continue ageing, with the average age rising from 40.0 in 2014 to 42.9 by 2039.

The number of people aged 60 and over is projected to increase from 14.9m in 2014 to 21.9m by 2039. As part of this growth, the number of over-85s is estimated to more than double from 1.5 million in 2014 to 3.6 million by 2039.

The number of people of State Pension Age (SPA) in the UK exceeded the number of children for the first time in 2007. By 2014 the disparity had declined to 0.2 million. The ONS currently projects that this situation will have reversed by 2019, with 0.5 million more children than those at SPA, but will then revert back by 2029 with 0.5 million more pensioners than children.

There are an estimated 3.0 million people with diabetes in England (2016).

In England the proportion of men classified as obese increased from 13.2 per cent in 1993 to 24.3 per cent in 2014 (peak of 26.2 in 2010), and from 16.4 per cent to 26.8 per cent for women over the same timescale (latter is the peak for the period covered).

The proportion of boys aged 2-10 classified as obese has increased from 10 per cent in 1995 to 16.8 per cent in 2014 and for boys aged 11-15 the proportion has risen from 14 to 21.7 per cent (peak of 24 in 2004 and 2011) over the same period.

The proportion of girls aged 2-10 classified as obese has increased from 11 per cent in 1995 to 14.1 per cent in 2014 (peak of 17 in 2007) and for girls aged 11-15 the proportion has risen from 16 to 18.5 per cent (peak of 27 in 2004) over the same period.

Winter looms once again and, according to headlines, the NHS is barely standing to face it. Is there enough time left to prepare for the increased demand? Steven Peak, director at Vanguard Healthcare Solutions, considers the question…

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